2/25 Sebastian PMPS 305 +10 316 Ketones 0.1

Justin & Sebastian

Justin & Sebastian

Member Since 2019
Yesterday's No Craziness

Summary from yesterday: reduced dosage to 3u for whole day, fed HC FF Gravy as main meal to mitigate lowered dosage while depot drains, Dr Elsey for snacking. Lo ketones at this morning's check.

AMPS 303

Plan for the day:
Feeding only LC wet food (Wellness Core Turkey & Duck). I'm home all day to keep an eye on him, will plan on testing +2, +4, +6, +8, +10 at least, with another ketone check this evening.
 
He's being a stinky butt about the wet food, put out some Dr Elsey and he ate a little of that. I'm going to the store in a bit to get some parmesan and hopefully that helps.
 
Also I'd say he's acting a lot more normal. He didn't get hyper but he also didn't go flop down and go right to sleep. He's more loafing and lounging than sleeping so far, so pretty normal cat behavior.
 
I hope he'll make his way back into some lower numbers on this dose. This is the 3rd cycle since you reduced. after tonight's cycle, the 7 u depot should be drained and you'll know if this dose can do it for him . You may have to increase.

I agree with Gill on yesterday's thread that I would hold off on the HC food. His numbers being this high right now don't need to be made higher. I hope the parm cheese will continue to help him eat. Oregano sprinkled on food has helped Bubba in the past. It sounds weird, but it has helped.
 
Really struggling with the food. I know he's hungry but he won't eat anything that's LC. I've tried forti flora, parmesan, oregano, I even tried crumbling up the DM Dry and sprinkling that on and the best I can get is 2 or 3 bites before he turns his nose up at it.
 
Are you still giving the ondansetron? It can be given twice a day. Maybe 30-40 minutes before preshot so it has time to work. You could give it now if you haven’t today.

I am with Bobbi, looks like you may have to increase.
 
Wendy&Neko said:
Are you still giving the ondansetron? It can be given twice a day. Maybe 30-40 minutes before preshot so it has time to work. You could give it now if you haven’t today.
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Yes, naseau isn't the issue though. He's not throwing up anymore, he just doesn't want to eat the LC food, no matter what I do. Even the appetite stimulant isn't helping. I've ordered syringes and it looks like we'll have to do syringe feeding until he decides to play ball.

And yeah, it looks like I'll have to increase the dose but are you guys suggesting I do that now or should I follow the TR protocol and wait 6 cycles?
 
Have you got any Freeze dried treats? most cat's find them irresistable, you can crush them and sprinkle on top of food to encourage him to eat.
I know these are available in the US, we have them here in europe too.
They are 100% meat so they won't add any carbs to his food.

https://www.orijen.ca/us/foods/cat-food/freeze-dried-cat-treats/original/

In the interim since it's important for you to get enough food into him, maybe you could mix a teaspoon of the HC into say 4 teaspoons of LC, see if that would get him more interested in eating the LC food.
I had to do something similar to get George interested in eating some low phosphorous food which he didn't find appealing at first (he loves the stuff now)

I agree with Bobbie and Wendy it looks like you may need to take the dose up.
 
Tried all that. I have freeze dried tuna and salmon. He normally goes nuts for tuna, so I ground some up and sprinkled it on. Two bites and he was done. Made some tuna water, he was going nuts when he smelled the tuna. Poured some on, wouldn't even touch it. Crushed up the DM Dry and sprinkled it on. Two bites and then wouldn't touch it. We're at the syringe now.
 
Justin & Sebastian said:
should I follow the TR protocol and wait 6 cycles?
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Whenever there is a reduction, you do not have to hold the dose for 6 cycles. If the dose isn't doing it you can take them back up once you know the bounce has cleared and the depot drained. With this being such a big reduction from 7 u to 3, I think you would be fine taking him back up the next cycle.

But, what dose? @Gill & George , 5 units was talked about before. With Sebastien still not eating well would 4 be a more reasonable dose for now?
 
Gill & George said:
you could mix a teaspoon of the HC into say 4 teaspoons of LC, see if that would get him more interested in eating the LC food.
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I have iced Bubba's food with baby food which he loves and I can usually count on him eating when he goes off his feed. You could try a thin layer of the HC on the top and maybe once he gets through it into the LC it will prime him to eat it.
 
Bobbie And Bubba said:
ut, what dose? @Gill & George , 5 units was talked about before. With Sebastien still not eating well would 4 be a more reasonable dose for now?
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I'm not sure what would be the best choice.
Justin & Sebastian said:
I agree too but am I taking the dose up on the next cycle or following protocol?
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Strictly speaking because of the Dr E dry, you are stuck with SLGS, that said when we have a kitty that has DKA in recent history, not eating well, and when we suspect not enough insulin on board, we do need to look at dosing differently.

Taking him up to 5 or even 4 units may also result in you having to steer numbers quite aggressively if they prove to be too much of a dose. None of us can know for sure.

Did you get those results back for the IAA and Acro? Or are they still pending?



With some cats when you take the dose up they can have a strong reaction to the new dose, so I would probably take him up tomorrow morning, since I know that pm monitoring is harder for you. (Unless we were to find that ketones rose sharply)
My concern with take him up 0.25u per protocol (which would mean a week on this dose) would be too slow and risk DKA.

I would like some of the other members experienced with DKA to take a look and see what they think @Sandy and Black Kitty has a lot of hands on experience with this sort of situation as does @Wendy&Neko

How far of schedule are you? I'm just thinking that if he is still high later in the cycle it may be possible to move him by more than just the 30min a day.
 
Just looking at the SS I see that you are trying to move the dose 15 min per cycle.
If he's in high yellow (rising) or pink at 8pm I think you would be OK to move forward a little more quickly, and shoot at 8pm but just for this cycle, you don't want to do that again tomorrow.

If the yellow is low or falling then I would stick with your original plan of 15min.
 
Nausea doesn’t necessarily mean vomiting. It could manifest as either lip licking, going up to the food, sniffing and turning away, hanging out by the water bowl, etc. I didn’t see ondansetron on the spreadsheet today, so that is why I asked about it. Maybe a 2 mg dose might be worth a trial.

The reduction to 3 units was not earned, therefore you do not have to wait a week and go up by 0.25 units. Think of it like a temporary reduction for a breather and depot draining. Keep in mind this is only cycle three of this dose and the 7 unit depot is still playing a part, so the numbers may get worse as time goes by on this dose. Iy’s also cycle 4 after the low, so there is still a bounce in progress. I would still increase, it that may play a part in the timing.

The amount of increase will depend on the plan for transition to low carb food and whether some dry/higher carb will remain in the future. And of course the ketone status. There are a lot of moving parts in this puzzle. It’s always easier to change one variable at a time. Even with food transitions, it’s easier to manage if change is done gradually. Easier on managing BG drops, and their tummy. Another thing to consider, his tummy flora may be upset with the food change, something as simp,e as a probiotic may help.
 
Have you tried raising his bowl? It might help if he's having problems with stomach acid or nausea. I would put a couple old paperbacks under Billy's bowl
 
Gill & George said:
Did you get those results back for the IAA and Acro? Or are they still pending?
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Still pending. I'll follow up tomorrow.

Wendy&Neko said:
I didn’t see ondansetron on the spreadsheet today, so that is why I asked about it.
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Yeah, I realized that I gave it to him at a bad time yesterday since it's every 12 hours and I gave it to him at like 2pm and obviously not going to be up at 2am. I guess I should have given it this morning but I suppose my sleep addled brain thought I needed to wait until this evening to get him on a regular cycle. So I was planning on giving it tonight.

Wendy&Neko said:
his tummy flora may be upset with the food change, something as simp,e as a probiotic may help.
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I've been dosing pretty much every meal with forti flora. It's one of the things that's been enticing him to eat. I've just been dusting it though, I'll give an actual packet instructed serving now.

billysmom (GA) said:
Have you tried raising his bowl? It might help if he's having problems with stomach acid or nausea. I would put a couple old paperbacks under Billy's bowl
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I'll give that a try

Okay, now for data update. Just did a ketone check and it's 0.2. +10 BG is 317.

Based on everyone's advice, I'm going to do this:
He's in the pink so I'll bump the dosage up by 1/2 hour just for tonight to get us back on schedule quicker, so 8pm instead of 830. Gets us back on schedule a day earlier.
Start giving the odanestron 1/2 hour before each meal, with the cerenia before morning meal.
I'm going to try adding a layer of HC with some forti flora and parmesan to try and entice eating. He's responded positively to the forti and parmesan in the past so I'm hoping that all three will get things going.
In the morning I'm going to increase his dose to 5u. There'll be a little extra carbs in the mix from the food and I'll be here to watch him if he goes low, so I'm pretty comfortable with that adjustment.
I'm still pretty wiped out and need another night of catching up on sleep so I'm not going to get any early evening checks but I'll get some late PM checks in the morning with a ketone check first thing.
 
My $0.02-
based on my experiences and observations and somewhat outside the box

Restoration before regulation.
  • He needs calories
  • He needs insulin
  • He needs to regain weight lost (How much weight does he need to regain?)
Ditch the dry It just muddies the picture

To paraphrase Dr. Lisa Pierson DVM -
the cheapest canned food on the market is better than any dry food on the market.


Right now I would not be so focused on carb% or brand name.
There must be some wet food brands/flavors that he likes and will eat consistently. So what if they are 15% or 20%... find them and use them.
Use anti-nausea and/or anti-emetics well ahead of meals to avoid him developing food aversions (which can happen with just one nausea or barfing incident)
Establish a consistent (times/amounts/carbs) feeding schedule and stick to it.. guiding, if needed, around the established schedule.

Use as much insulin it takes to keep his BG under the renal threshold and ketone readings negative,.

Consider adding some R -

If you look at BKs graph you can see exactly when the IAA started to break - it was following surgery to remove a benign lump 10/23/2008, 4 months after his 2nd hospitalization for DKA
At the time he was up to 13.5u Lantus along with 3-6u R per cycle, so about 45u per day combined.
All of a sudden things started changing and on 10/30/2008 I stopped using daily R. BK had earned his first reduction and it was 10u
Had those 10 additional units been Lantus it would have been a different story - 10u of depot drainage action-imagine that...

Understand that this was not some strategy we came up with-it's just how it happened. It was in retrospect that we realized how using that much the use of R allowed for such a huge instant reduction in dose. A literal life saver for an IAA kitty experiencing the sudden return of insulin sensitivity.

For Sebastian, supplementing with R might give him the wiggle room to eat higher carb food until he regains his lost weight and vigor.

Stabilize the food, stabilize the Lantus dose, regain weight lost to illness and regain vigor.

Then think about following the TR protocol: incrementally reduce carbs, waiting to see if a reduction is called for, reduce insulin when you see the signal, lather, rinse, repeat until you get him on all LC wet.


BK insulin graph (600x337).jpg
 
Sandy and Black Kitty said:
He needs to regain weight lost (How much weight does he need to regain?)
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About 2lbs. Before the p'titis in November he was just shy of 13lbs. Since then he hasn't gone above 12lbs and is currently hanging around 11.

Sandy and Black Kitty said:
Right now I would not be so focused on carb% or brand name.
There must be some wet food brands/flavors that he likes and will eat consistently. So what if they are 15% or 20%... find them and use them.
Click to expand...
He did seem to take to the FF Gravy so I think that will work.

Sandy and Black Kitty said:
Use as much insulin it takes to keep his BG under the renal threshold and ketone readings negative,.

Consider adding some R -

If you look at BKs graph you can see exactly when the IAA started to break - it was following surgery to remove a benign lump 10/23/2008, 4 months after his 2nd hospitalization for DKA
At the time he was up to 13.5u Lantus along with 3-6u R per cycle, so about 45u per day combined.
All of a sudden things started changing and on 10/30/2008 I stopped using daily R. BK had earned his first reduction and it was 10u
Had those 10 additional units been Lantus it would have been a different story - 10u of depot drainage action-imagine that...
Click to expand...
I'm still waiting on the results of the IGF and IAA but I'm all for this. However so far I haven't found anyone who's able to guide me at those high levels of Lantus or using the R. Everyone has said they hope someone with experience can get in but no one has. I have the Lantus and I have the R, I just need the coach on how to increase the Lantus that much and how to administer the R. What do I need to do to find someone who can help me?
 
PM +10 BG is 316. Ketones 0.1. Was a little worried ketones were going to have jumped because he hasn't been eating enough so I'm relieved.

I'll also add to my above response, I do think there is still a bit of naeseu in the mix. I found two very small puddles this morning, one looked like a late cycle throw, the other more like some spitup, neither had undigested food. I'm not opposed to syringe feeding LC wet and I feel that might be preferable to giving HC gravy.
 
I think of it this way, and it may not be totally correct. Nausea is the feeling of your tummy churning and the feeling you may vomit. Vomiting is the action.
Again, I'm probably not totally correct, but Cerenia helps to stop vomiting (it's often prescribed to help with car sickness in dogs) and helps with nausea. Ondansetron works in a different way than Cerenia and helps to alleviate nausea, the feeling of stomach churning and possibly vomiting. Often people will use both.
When a kitty vomits clear liquid or froth usually in the early morning hours, it is from excess stomach acid from their tummy being empty.
I would mention again about wanting someone to help you with R, when you start today's new thread. I am not available enough, right now to help you as I work away from home long hours and have appointments on the weekend.

Keep up with those ketone tests. Be sure to order more ketone strips before you are running low.

Good luck with the dose, and sending eating vines to Sebastian.
 
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